Provider Demographics
NPI:1942602768
Name:GOMEZ, OLGA JUDITH
Entity Type:Individual
Prefix:MS
First Name:OLGA
Middle Name:JUDITH
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 167 KM 2 # 8
Mailing Address - Street 2:BARRIO DONA ELENA SECTOR EL SALTO
Mailing Address - City:COMERIO
Mailing Address - State:PR
Mailing Address - Zip Code:00782
Mailing Address - Country:US
Mailing Address - Phone:787-632-2072
Mailing Address - Fax:787-875-0312
Practice Address - Street 1:CARR 167 KM 2 # 8
Practice Address - Street 2:BARRIO DONA ELENA SECTOR EL SALTO
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782
Practice Address - Country:US
Practice Address - Phone:787-632-2072
Practice Address - Fax:787-875-0312
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR54417171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator